Regular Monitoring Chart Gives Leading The Change
1) Examine a major change in your life, whether personal or work-related, that you found challenging and difficult to make.
2) Describe the situation in a paper of 1,000–1,200 words. Include the factors discussed in the module and how they affected your reactions to the change. Include a discussion of how these factors could have been used to make the change easier or smoother.
3) Refer to the assigned readings to incorporate specific examples and details into your paper.
4) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
5) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment
Leading the Change Process
Any experienced business leader will tell you that leading and managing a major change process is one of the most challenging activities a leader can undertake, and it has the potential to be a huge success or a dismal failure. If the process of effective change implementation is well understood and the execution is crisp, the pendulum swings strongly to the side of success. In this module, we will review how humans view and process change, techniques to manage the emotional and psychological framework of change implementation, and the things to consider during execution of the change.
The Psychology of Change
Population estimates show that approximately 20% of people enjoy change and actively seek it out, creating it where it does not exist in some cases. However, the remaining 80% would rather have a root canal procedure than undergo change. What are the differences in how these people view change, and how does that affect a change initiative?
People who enjoy change tend to have high energy, are very self-confident, can be creative and innovative thinkers, and have great faith that they can figure out an answer for just about any situation. They dislike boredom and routine, valuing stimulation and excitement instead. Change can provide these factors. These people are not afraid of change and tend to see it from the positive viewpoint of something to be anticipated, enjoyed, and conquered. One possible characteristic of people who relish change is a history of frequent job changes, around every three to five years. They may also move more frequently than others, enjoying the change of finding a new place, settling in to a new home, and changing friends and co-workers, grocery stores, cleaners, and other such necessities.
People who fear change tend to be more stable and steady, value consistency and reliability highly, see themselves as modest and unassuming, and generally have a strong fear or anxiety around unknown or unfamiliar situations. They prefer regular, routine activities and functions, do not like unanticipated events or unplanned occurrences, and strongly dislike what they think of as chaos. They relish high degrees of organization and predictability in their environments. Once they are comfortable in a job, a location, or a relationship, it is unlikely that they will change without great angst and anxiety. They fear unpredictable situations, exhibiting an underlying belief that they may not be able to manage or cope. They value the opportunity to be careful, analytic, and deliberate in their approaches to situations. They tend to plan carefully and detest disruptions in their daily routine.
How do these concepts apply in the work setting? In most sizeable groups, a small percentage of people will embrace change because it is new, different, and stimulating. A small percentage will resist it with all their might, due to their fears of the change and what it could do to them. The majority are likely to be cautious, careful, and watchful for the impacts of change but can be supportive if the change helps them meet a goal that is important to them.
Those who fear and dislike change generally require consistency in their work and personal lives. They do not have a strong belief in their own abilities to manage the impact of change in their lives and are anxious about outcomes. Their past experiences with change have likely been painful, such as the loss of a loved one, a move from a familiar place to a place that is uncomfortable for them, the breakup of a treasured relationship, etc. Therefore, change is associated with painful experiences for these people. For people who like change, it is generally seen as an opportunity to grow and have fun.
Leading Through Change
What techniques help to lead a change initiative? The following explores several and how to use them.
Destabilize satisfaction with the status quo.
Nobody willingly changes when they are happy and content with the way things are. Even those who enjoy change need to become bored or dissatisfied with the status quo before they are ready to move in a different direction. There are several ways to destabilize the status quo:
In meetings, ask people to list all the things they dislike or are unhappy about with the current situation. Write these down on flip charts and save them–you will need them later.
Encourage griping and keep careful note of the common themes that people fuss about as they relate to the upcoming change. If you can tie a common dissatisfier to something in the change that will improve the dissatisfaction, it will help to bolster acceptance of the change.
Ask people to describe their environment or the situation as if it was perfect. This begins the process of detaching people’s emotional commitments to the current situation and starts them thinking about change as a way to make things better.
In a health care setting, staff and physicians have generated patterns of providing care that make them comfortable and that have worked for them in the past. They may believe that these patterns ensure that their patients receive excellent care, and, therefore, may be more resistant than people outside health care to making changes that affect how they function. This makes the need to reduce their satisfaction with the existing system even more important prior to initiating change.
Let the people most affected by the change participate in the design and implementation.
One of the biggest fears of change is that it will be thrust or imposed upon people and that they will have no voice in the design or implementation of the change. They worry that the design will be flawed in some way or that the change will make things worse, and if the people most affected do not have a voice in the design, it is very likely that mistakes will be made and a self-fulfilling prophecy will be created.
As change is implemented, a key component of success is the buy-in and support from the people who will use the change or who will function within it. They can make or break a change process in a number of ways, and it is critical to build their support or at least their willingness to trial the change prior to implementation. This buy-in is much more likely to occur when the users have the chance to be involved in all stages of the change process, from the original concept, through design and implementation, to ongoing monitoring for outcomes. If everyone cannot be directly involved in the change, the effective change agent will arrange for updates and briefings on the design work to date so that users can give input and reactions and so that they are aware of the direction the design is taking.
As an example of this, a hospital system that was beginning the early implementation of an electronic medical record (EMR) started its process by identifying key informal staff leaders and influential physicians and forming them into an operational steering committee that was deeply involved in the design of the new EMR. The inclusion of these stakeholders in the early process turned some who were very negative at first into staunch supporters of the new system. They were also able to stop some design approaches that would have been major mistakes and redo them to make them more functional. This saved months of frustration during implementation.
Tie the change process into improvements that the participants wish to see.
Be sure you can track at least some of the improvements participants listed in the flip charts done at the beginning of the change process back to elements of design in the change process. If the change is partially designed to relieve some of the problems brought out in the earlier discussion, it is a key point to communicate to participants, as a point of improvement. It can help with buy-in to review the flip charts and demonstrate how some of the issues are improved through the change.
Use the improvements to answer the basic question of everyone who goes through change: What’s in it for me? There is absolutely nothing wrong with asking this question, and it is part of the basic foundation for building support for the change process. To the degree that people see something desirable for themselves in the change process, they will tend to support it. The more desirable the outcome, the more strongly people will tend to support the change. The smart change agent looks for synergy between the wants and needs that people express in their discussions and the connections of those wants and needs with the change process.
In the example listed above, the key physicians involved on the design committee served as the voice of the medical staff in terms of changes that would make the system work better for other physicians, especially as it applied to using the computer as a means of writing patient care orders. The physicians had been very frustrated with numerous phone calls from unit staff who could not read their handwriting. The new system removed that problem and became a source of satisfaction. In addition, orders routed automatically to the relevant hospital departments, which sped up the testing process and the delivery of medications to patients. This was another source of satisfaction. When other physicians grumbled about having to type their orders into the computer, the physician representatives on the design committee pointed out the advantages and the grumbling died out.
Be prepared for the “Good Old Days” phenomenon.
When a major change is initially implemented, it is essential to expect that things in the work environment will initially get more disorganized and less effective for the first weeks or months. When new behaviors and processes are implemented, it takes time and practice to become efficient at them. The more complex the change, the longer the period of confusion and inefficiency will be after implementation. People generally do not expect or anticipate this and can respond by thinking that the change is not working properly. The important action to take is to prepare people for this period so that they can expect it, recognize it for what it is, and can work their way through it.
When the initial expectations for improvement from the change are not initially seen, it is common for people to begin to yearn for the “good old days.” Their memories are not logical or accurate about just how good those days were, and what they are really yearning for is stability and familiarity. This is another time to pull out those flip charts from the beginning of the process just to remind people of their own dissatisfaction with the way things used to be.
It can be very helpful when initiating major change to set an expectation that no modifications to the change will be made for a set period of time after implementation. This enables the system and the people to begin their adaptation to the change and buys time to differentiate between problems as a result of the learning curve and problems as a result of flaws in design. Three to six months of no modifications is generally an appropriate time for a significant change in process, but the change agent will need to assess each situation.
Celebrate and recognize early successes.
It is important to make people consciously aware of the change process and where it is meeting or exceeding expectations and resolving existing problems. Associating the change with positive and fun events is helpful, and keeping successes in front of people is essential. People tend to focus on what is not working more than what is. Visual depictions of successful implementations, such as graphs, pictures, or improved products, also help.
Monitor, Monitor, Monitor. When designing the change, you need to have specific and clear outcomes that result from the change. These should be developed from the expectations for improvement that drive the change process. Be sure that these outcomes are as specific and measurable as possible, and begin your measurements at the point of implementation. If you do not have an existing baseline on the measures, you should begin to track them before the implementation so that changes can be measured. Once the monitoring has started, be sure to post the results where all affected parties can see them. There is considerable research that shows how changes implement more fully when a regular monitoring chart gives updated feedback. The goal with all changes is to make them become a part of the expected landscape in the environment. In general, it can take over 2,000 repetitions to make a behavior habitual.
Performing the changed behavior or process over and over will settle it into a normal work environment as part of the daily routine. If the change agent listens to the language of the people affected, it is helpful to pay attention to how often they speak of the new behavior or process as “the change” and how that frequency tends to diminish over time. Over about one year of constant and consistent implementation, the change shifts from being something new and different to “the way we always do it.” A subtle way to test this, after a year, is to ask people’s opinions on whether the process needs to be changed again. If they are comfortable with the first implementation, it is very likely that they will actively resist any suggestions for more change.
These basic principles will be seen in the health care environment. For example, a change project at a community hospital was designed to change the caregiver mix away from an all registered nurse (RN) team to a team of mixed RNs and patient care technicians. The goal was to reduce the labor costs by decreasing RNs and adding lower cost support personnel. Not surprisingly, the RNs were less than thrilled initially about the change. However, the change agent started the process by asking the RNs to list everything they had to do on a daily basis that did NOT require their license, skills, and abilities. The list was very long, and they were very frustrated by it. When they discovered that this list formed the core of the patient care technician job description, they were very pleased to see that their concerns had been addressed in the design. They were even more accepting when they were asked to help select, hire, and train the technicians, since this helped the nurses feel more in control of the change. Regular assessments of the change process, regular meetings to smooth out rough spots, and feedback opportunities all helped through the initial startup months. The final measure of success was one year, when the RNs were asked whether they would like to give up the technicians and return to the old model. Overall, 100% of them asked to keep their technicians. The change had institutionalized successfully.
Change can be difficult to implement successfully and almost always fails without careful planning of the implementation and careful assessment and thought about shifting the psychological and emotional reactions of the affected staff from a platform of resistance toward making acceptance easier. Once those dynamics are factored into the planning, communication, and monitoring of the change, they can help to avoid pitfalls and enhance the ultimate implementation. Change can be difficult under the best of circumstances, so any useful techniques of implementation can make the change go more smoothly and effectively.
1. Change Management – The Systems and Tools for Managing Change
Read the “Change Management – The Systems and Tools for Managing Change” page of the Change Management website.
1. Actualizing Culture Change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) Program
Read “Actualizing Culture Change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) Program,” by Doll, Cornelison, Rath, and Syme, fromPsychological Services (2017).
2. Change is Constant, but Improvement is Rapid
Read “Change is Constant, but Improvement is Rapid,” by Joshi, from H and HN: Hospitals and Health Networks (2014).
3. Leveraging Change for Continuous Process Improvement
Read “Leveraging Change for Continuous Process Improvement,” by Bhandola, from Pharmaceutical Technology (2015).